We are not the world: Inside the “perfect storm” of famine

Like the four countries facing extreme hunger crises today, the famine that gripped Ethiopia from 1983 to 1985 struggled for attention until it was far too late.

There was conflict. There had been years of consecutive drought – similar to Somalia now. The government spent its money on fighting, not aid. The rich world eventually reacted, with Bob Geldof and Live Aid at the forefront of a public funding campaign. But access in a time of war was hard. By 1984, 200,000 mostly starving Ethiopians had died, young children often the first to go. The final toll was closer to one million.

More than three decades later, the stakes are arguably even higher. A badly strained humanitarian system finds itself facing not one but four vast challenges. In all, more than 20 million people are at risk of starvation and famine across South Sudan, Somalia, Yemen, and northeastern Nigeria.

Much has been learnt since 1984: the value of building resilience before crises arrive, the role climate change plays, the imperative of early conflict prevention, the importance of cash aid, the need to prioritise water as well as food. Nonetheless, the goal posts for those struggling to reach the world’s most vulnerable and provide them with life-saving assistance have shifted. Why?

The simple answer is conflict. It’s the one factor that afflicts all four famine-facing regions listed above. And that’s not to mention how the effects of war in places like Iraq and Syria, including the mass migration to Europe, have drained valuable humanitarian resources and donor dollars.

As Nancy Lindborg, president of the US Institute of Peace, pointed out in testimony last week before the US Senate Foreign Relations Committee, “humanitarian assistance flows have shifted from 80 percent of global aid going to victims of natural disasters to now 80 percent going to assist victims of violent conflict.”

Unfortunately, Lindborg’s remarks may well have fallen on deaf ears: President Donald Trump’s administration is threatening draconian cuts to the State Department’s budget, affecting US funding for everything from UN peacekeeping to the United Nations Development Programme and UNICEF.

And garnering the attention required to generate the $4.4 billion the UN says is required by July to stave off a humanitarian “catastrophe” is only part of the battle. Devising the correct response strategy and securing the necessary access in complex and fragmented war zones is likely to be even harder.

These four famines or near-famines do have similarities, but they also have different origins, different trajectories, and therefore different needs. Local factors are at play, with each country prone to its own combination of flaring conflict, weak governance, poor infrastructure, and failing markets.

Yemen

Famine hasn’t officially been declared (yet) in Yemen, but, with more hungry people than any of the other big three areas at risk, this feels rather like a technicality.

A reminder of the UN definition: At least 20 percent of households in an area with extreme food shortages and a limited ability to cope; acute malnutrition rates exceed 30 percent; and a death rate exceeding two persons per day per 10,000 persons due to lack of food. As Somalia found out in 2011-2012, famine doesn’t need to have been declared for many to die. Nearly half its starvation deaths occurred before it met this statistical definition, including almost 30,000 children in just three months.

Right now, 17 million of Yemen’s overall population of 27.4 million are classified as food insecure and 3.3 million people, including 2.1 million children, have acute malnutrition. Some half a million children are even worse off – with severe acute malnutrition – UNICEF counts this as a 200 percent increase since 2014.

Yemen’s crisis is entirely man-made (UN relief chief Stephen O’Brien said as much in recent comments). As such, to the few paying attention, it’s been like watching a car crash in slow motion.

Even before fighting began two years ago, Yemen was a poor country with a chronic hunger problem. But it was, for the most part, manageable: Aid agencies could move about the country with relative ease; most families could buy their meals at market. That was before the Houthi rebels reportedly helped themselves to the reserves in Yemen’s Central Bank, the country’s sole remaining neutral institution. Their rivals, the government and allies of ousted but internationally recognised President Abd Rabbu Mansour Hadi, moved the bank to their southern stronghold of Aden in September, and since then salaries of public sector workers on all sides of the conflict have gone unpaid.

The economy is now in complete freefall, with 80 percent of families in debt. “Middle-class people who used to be able to feed their families no longer have the cash to get food, even when it is available on the open market,” World Food Programme spokeswoman Abeer Etefa explained.

Getting food into Yemen is harder than ever, and becoming pricier too. This matters a great deal in a country that even before this war depended on imports for 90 percent of its food.

Commercial flights aren’t an option – the Saudi Arabia-led coalition has banned them for months. Hodeida port, once the main entry point for cargo ships bringing fuel, food, and medicine, was hit in August 2015. The airstrikes knocked out four of its five functioning cranes.

These days, ships are delayed for weeks at port – if they make it through a UN inspection and a slightly less formal one by the Saudi coalition. Mark Kaye, conflict and humanitarian advocacy advisor for Save the Children, told IRIN the majority of supplies are now unloaded by hand, and that his organisation is finding the private vessels it pays to bring in vital medicines increasingly hesitant to take on the risk.

This is compounded by an uptick of fighting off the coast – the latest example being more than 40 Somalis killed when their boat was struck recently, allegedly by an Apache helicopter.

WFP also struggles with delays (although it has its own ships), and in February it purchased four mobile cranes – to the tune of $3.8 million – meant as a stopgap to “boost the port’s capacity in handling humanitarian cargo”.

A spokesperson told IRIN the vessel carrying the cranes “had been waiting for approval for nearly two weeks to berth [at Hodeida]... but was denied the required security clearances to offload the cranes.” WFP didn’t respond when asked who exactly denied the clearance.

Food insecurity predictions for March-July 2017 - FAO/IPC

So the holdups continue, and they have real consequences. When Save the Children’s medications were delayed at port, Kaye said mobile medical teams “were running at the bare minimum”.

“That means you have to make really tough choices,” he added. “If you are treating the child who comes in and is critical, you can’t treat the child who isn’t critical today but will be next week.”

Once aid makes it into Yemen, it’s a dangerous obstacle course to get it to the most needy, as much of the worst malnutrition is in the areas most heavily impacted by fighting. And some places are under siege, like Taiz city and governorate, making distribution even harder.

“Every party to this conflict makes it extremely difficult for aid agencies and aid workers to get to some parts of the country,” said WFP’s Etefa. She described Yemen, with seven million in need of emergency food assistance to survive, as a “perfect storm… conflict, collapsing economy, limited capacity at ports, [Saudi and internal] blockades, more poverty, and a country that has had chronic hunger problems.”

The unthinkable may be about to get worse. There’s fear ground fighting is headed for Hodeida, potentially giving the Saudi-led coalition a road to the Houthis in Sana’a and shuttering the port completely. This is what keeps humanitarians up at night, and what might just throw Yemen into full-fledged famine.

South Sudan

The South Sudanese government has already declared famine in two counties, and the UN says 5.5 million people will be on the verge of starvation by July if they don’t get food.

There’s a dramatic shortfall of funds to stave off the looming catastrophe, with only 18.5 percent of the appeal funding received so far. But that isn’t South Sudan’s biggest problem. Even if humanitarian agencies get the entire $1.6 billion they’ve asked for this year, they’ll struggle to deliver aid to those most in need.

The country is a bewildering patchwork of armed groups, including various rebel factions as well as the army and government-aligned militias. All sides have engaged in ethnically motivated mass killings, and sexual violence has reached “horrifying” levels, according to the UN.

Aid agencies are forced to take extraordinary measures to try to find people in need and ensure their staff members don’t become casualties too, skirting around armed groups to get aid to people in remote areas.

“We have small planes that land on bush runways. We hire porters to walk for hours and hours and hours to get to these islands where people are hiding, where teams are working,” explained Nicolas Peissel, a project coordinator for Médecins Sans Frontières who has recently been to Leer and Mayendit, the counties, both in rebel-held areas, where famine has been declared.

“We take canoes,” he told IRIN. “There's one place it takes us over 18 hours to get medicine to them by canoe; so we use whatever is available to us."

But no amount of precautions can ensure safety for aid workers in South Sudan’s complicated conflict. They have been beaten, kidnapped, and killed.

In one recent attack, unknown men ambushed a team with the International Organization for Migration that was travelling by convoy on its way back from an area where cholera had broken out. Two people died from gunshot wounds and three others were injured.

Then, on 25 March, six more aid workers were killed in an ambush. At least 79 aid workers have been murdered since South Sudan descended into civil war in December 2013.

“Those other areas at risk of famine could have a chance of averting catastrophe if humanitarian access is secured and respected,” the UN’s emergency aid coordination body, OCHA, said in a recent report.

But judging by the actions of both the government and opposition so far, there’s little chance that will suddenly begin to happen.

Speaking to the Security Council on 23 March, UN Secretary-General Antonio Guterres noted that the peace process is at a standstill, while government forces have been looting humanitarian compounds and blocking access to people in need. The government has refused to heed warnings from the international community that it must cease such actions to save its people from starvation. “On the contrary, what we hear most often are denials – a refusal by the leadership to even acknowledge the crisis or to fulfil its responsibility to end it,” said Guterres.

On cue, South Sudan’s representative told the Security Council that his government has cooperated with the UN and its forces have not targeted civilians or perpetrated sexual violence – claims so obviously false they would be laughable if the situation was not so tragic.

So, the government continues down its path of denial as humanitarians wring their hands, and the world’s newest nation staggers inexorably toward a devastating famine.

Northeast Nigeria

Things are very different in Nigeria. Eight years into the Boko Haram crisis, the momentum of the humanitarian response is finally beginning to build.

But the extent of the problem is huge. Some 5.1 million people are food insecure out of a population of 5.8 million in the three affected northeastern states. But only a fraction – 1.9 million – are being reached.

This is a crisis of both funding and access. Some $1.1 billion is needed this year for humanitarian action, but the response plan has so far received only $160 million. And despite the government’s repeated promise that the insurgency has been broken, the security situation is fluid, limiting the reach of aid workers. That means the humanitarian presence is at its weakest in the areas where it is most urgently needed.

The emergency has been slow to reveal its true scale. Boko Haram was in control of much of the northeast by 2014, effectively locking up the rural population. Those that could escape did, mostly heading to Maiduguri, the capital of Borno State. But little was known of the needs of the many more left behind.

It’s now clear they are substantial. The military’s advance is breaking Boko Haram’s hold, and, as it does, people are emerging, looking for help. “They are hungry and malnourished; some are incoherent; they have clearly been through a lot,” said Malik Samuel, field communications manager for Médecins Sans Frontières.

As the military liberates the last remaining areas of the northeast, along the northern border with Niger, it’s possible that pockets of starving people in localised famines will be found. The aid response is already stretched. Will it be able to cope? Can it be sustained?

The hope is that it will be more effective than last year, when the USAID-funded early warning system, FEWS NET, said that famine had “likely occurred” in Bama and Banki – two towns the military recaptured in 2015.

The army was unable to care for the people arriving from the surrounding countryside. Although Bama is only 74 kilometres from Maiduguri, as many as 2,000 “famine-related deaths” may have occurred. The situation was likely worse outside the town. We don’t know, because the area was deemed too high-risk to venture into by most aid agencies.

Bama is now flooded with aid workers. “The government and NGOs stepped up,” said Samuel. “Across the northeast, the aid response is better.”

It’s certainly more coordinated than it was. There are more skilled staff available, and the at-times tetchy relationship with government authorities has become smoother. But there are still serious gaps. The army nominally controls 23 out of the 27 Local Government Areas in Borno. But its hold is typically restricted to the main town in the area, where the aid operation is based, feeding the displaced who make it out of still-inaccessible rural zones.

“In some [LGAs], there is still not enough food [distributed],” said Adrian Ouvry, regional humanitarian advisor for Mercy Corps. “In some areas, there is not enough fuel wood, so even if you have the food you can’t cook it.”

Food security is also about functioning markets: Farmers need to be able to sell their produce. But those trade links between the towns and the countryside have been severed by the conflict. Boko Haram turned to requisitioning the food it needed, and as a result farmers planted less and less.

The government’s counter-insurgency approach also deepened the isolation of the rural population. Fearful of Boko Haram’s mobility and the threat of infiltration, it banned fuel sales and restricted movement. The closure of the borders – where it could be enforced – also hit agricultural trade, especially the once-thriving livestock business that historically stretched as far as Central African Republic.

Nigeria is in recession as a result of slumping oil prices and the naira’s freefalling exchange rate against the dollar. Year-on-year inflation hit 19 percent in January, pushing up prices of local and imported staples. This is also being felt keenly in neighbouring Sahelian countries that are struggling already and depend on smuggled Nigerian produce.

Some 1.8 million people are displaced in the three northeastern states of Adamawa, Borno, and Yobe. The bulk are in Maiduguri, whose population has doubled to two million. Rather than settling in poorly serviced official camps, more than 80 percent of these victims of the war live with friends and relatives in the community, further straining households.

Food insecurity projections for June-August 2017 - FAO/IPC

Nigeria’s northeast had always been food secure and self-sufficient. But for a third consecutive year farmers have been unable to return to the land for the planting season. The Borno State government, possibly as a sign of frustration, has called for IDPs to head back to their homes by 29 May.

This is widely seen as an impossible goal given the insecurity, the lack of government services, and the deliberate destruction of infrastructure by Boko Haram, which, according to the World Bank, includes 30 percent of homes in Borno.

The best that could be achieved would be the return of people to the largest towns in the LGAs, but this only relocates the problem of caring for those in need to strained urban centres.

The Nigerian government has given assurances that nobody will be forced to move against their will. That is not the case with neighbouring Cameroon, which is “deporting Nigerians on a daily basis”, said MSF’s Samuel. This is despite a tripartite agreement, also signed by the UN’s refugee agency (UNHCR), that forbids refoulement. Nigerians are being forced onto trucks and dumped on the border, where they have a long wait – sometimes weeks – before they receive any assistance.

It’s a reminder that this is a regional emergency. Boko Haram attacks have spilled over into Chad, Niger, and Cameroon, all of which are sheltering Nigerian refugees and their own displaced as a result of the violence. And this is a fragile Sahelian zone, also grappling with the growing impact of climate change and endemic poverty.

Somalia

“Here we go again” might be a typical reaction to the slow-motion disaster that has left 5.5 million people in urgent need of food aid in Somalia.

Drought? Check. Conflict? Check. Rampant poverty and underdevelopment? Check. An international appeal for almost a billion dollars? Check again. So is this a repeat of 2011, when a famine claimed around 250,000 lives? There are several parallels, but also some significant differences, both in the context on the ground and in the humanitarian response.

The drought itself is worse and has lasted much longer than the one that preceded the 2011 famine. Of the four countries highlighted, only in Somalia is there a drought. Almost the whole country has suffered near-total crop failure, leading to sharp price rises; some grains cost double what they did a year ago. Livestock herds – the equivalent of bank accounts for many – are dying in vast numbers, with widespread sickness driving down the value of surviving animals. The cost of labour, meanwhile, has plummeted. All this means households have considerably less money to buy food that is a lot more expensive.

Large swathes of the country where the food crisis is at its worst, such as in the Bay, Bakool, and Juba regions, where al-Shabab is the de facto authority, are no-go areas for almost all aid agencies, who are denied permission to work there or simply not allowed through checkpoints. The security risks to aid workers in Somalia are also very real: last year there were 165 violent incidents and 16 aid workers killed.

But inaccessibility and al-Shabab’s presence are not the only factors at play. The adjoining regions of Sool and Sanaag are in the second most severe category of food insecurity but they lie well north of the Islamist group’s main theatre of operations, between the self-declared independent state of Somaliland and Puntland, a semi-autonomous region. Drought there has been especially fierce, while there has been very little investment in resilience projects and humanitarian presence is minimal (unlike in Somalia as a whole, where more than 300 different relief agencies operate).

Across Somalia, access is generally better than it was in 2011, with an atomised humanitarian presence in aid hubs from which surrounding villages can be reached. This is one reason why today’s map of food insecurity, despite the more severe drought, is less alarming than that of four years ago.

The response to that disaster was widely derided as too little much too late and led to considerable soul-searching and the drawing up of “lessons learned”. Chief among these was a determination to ensure that, come the next crisis, aid would be delivered from points much closer to people in need. Mobile health clinics, which play a key role in addressing acute malnutrition and drought-related diseases such as cholera, will, funding permitting, reach further and wider than previously.

The UN’s Operational Plan for Pre-Famine Scale-Up of Humanitarian Assistance calls for some 4.6 million Somalis to be given access to health services. And the scaling-up of cash-based programming – which accounts for half the planned food response, with the food itself provided by the private sector – is another example of more proximate delivery. In many cases, this assistance arrives directly to people’s phones via mobile money services.

Additional components of the plan include targeting 200,000 severely malnourished children with therapeutic interventions (such as peanut pastes) and a further two million children for treatment and prevention of moderate acute malnutrition.

Another important lesson learnt was the importance of “resilience” – ensuring people are better able to absorb, recover from, and reduce the threat posed by shocks such as severe droughts.

Since 2011, millions of resilience dollars have poured into Somalia. Most have been invested at the very local level, to construct sustainable water sources, diversify economies, and provide microfinance and training for small businesses.

Gabriella Waaijman, regional director for the Norwegian Refugee Council, said shifting from repetitive crisis-response to longer-term preventive action had made a significant difference in Somalia. As the current drought took hold, “villages with resilience projects were better off,” she told IRIN. “We saw that the first population movements were from villages where such investments had not been made to those where it had.”

Food insecurity projections for February-June 2017 - FAO/IPC

But if resilience has been so successful, how come Somalia’s humanitarian crisis has now spread virtually nationwide?

“The seatbelt has saved a lot of lives,” said Waaijman. “But if you have a head-on collision with a freight train it won’t do you much good.

“We should stay the course. There’s some modest evidence of positive outcomes at the local level, but we’ve only been at it for a couple of years. As long as we don’t say, ‘let’s try something new again’, we have a bit of a chance.”

Solutions?

Joined-up thinking that bridges the historic divide between emergency response and development aid could build better resilience, with investment in infrastructure, agriculture and water resources.

Innovations such as risk insurance and catastrophe bonds also show promise in helping protecting people from the worst when the rains fail or bigger shocks come. And increasing pressure is being brought to bear on donors to provide multi-year financing for longer-term projects on protracted crises.

Cash aid is all the rage and can be extremely effective in providing access to food to people with no money, even by mobile phone. But such payments don't work so well in parts of South Sudan where road infrastructure is poor and markets are only poorly integrated, even in the dry season, or in areas of Nigeria cut off by Boko Haram. As long as conflict prevents markets from restarting and aid can’t reach those in need, hunger and famine will almost certainly get worse.

“The point is that emergency assistance only helps if people can access it," Dan Maxwell, who leads the research programme on food security and livelihoods in complex emergencies at the Feinstein International Center, told IRIN. "Resources are critical in all four of these countries, but so is the question of humanitarian access – and of ensuring that warring parties actually respect the rights of people caught in conflict to access assistance, as enshrined in International Humanitarian Law. Beyond adhering to IHL, much more emphasis needs to be put on actually resolving these conflicts – some of which have dragged on for years – and for which any amount of humanitarian assistance is but a palliative.”

Guterres has made early conflict prevention the centrepiece of his reform agenda for the United Nations, but he has had to be frank about the challenges ahead, especially given the Trump administration's apparent determination to pull the US back from global causes.

“It has proved very difficult to persuade decision-makers at national and international level that prevention must be their priority – perhaps because successful prevention does not attract attention. The television cameras are not there when a crisis is avoided,” he told the Security Council in January.

Even if the TV cameras were there, would anyone be watching? It took a picture of a small dead boy, Alan Kurdi, going viral to wake the world up to the so-called European refugee crisis. In 1984, televised images of emaciated Ethiopian children belatedly spawned pop concerts, chart-toppers, and a global outpouring. What will it take now?